【脉】 出鱼际，逆气喘息。脉弦为咳。咳而浮者，四十日己；咳而弦者，相其
人强，吐之
而愈；咳而脉虚，必苦冒；咳而沉者，不可发汗。喘咳上气，脉数有热，不得卧者死；上气
，面浮肿，肩息，其脉浮大者死；久咳数岁，脉弱者生，实大者死；上气，喘息低昂，脉滑
，手足温者生，脉涩四肢寒者死；咳，脱形发热，小坚急者死；肌瘦下脱，热不去者死；咳
嗽脉沉紧者死，浮直者生，浮软者生，小沉伏者死；咳而呕，腹胀且泄，脉弦急欲绝者死；
咳嗽羸瘦，脉形坚大者死。暴咳脉散者死。浮为风，紧为寒，数为热，细为湿，此生于外邪
之所搏；浮紧则虚寒，沉数则实热，弦涩则少血，洪滑则多痰，此生于内气之所郁。
【因证】 因风、寒、火（附腹满）、劳、痰。
风寒为病主乎肺，以肺主皮毛而司于外。伤之。腠理不疏，风寒内郁于肺，清肃之气不
利而
生痰动嗽。又寒饮食入胃，从脾脉上至于肺则肺寒，肺寒则内外合邪，因之而咳。火之嗽，
病因火盛生痰、铄肺金也，遂成郁遏胀满。甚则干嗽无痰，或唾血痰。劳而咳嗽，皆好色肾
虚，则子能令母虚，气血俱虚，阴虚则生火，肺金耗败，而津液、气血皆化为痰矣。痰者碍
清气升降，滞气而不行，遂成诸咳嗽之证。
论咳逆痰嗽分为二 咳者，谓无痰而有声。肺气伤而不清，而上逆，皆关于肺也
。嗽者，谓
有痰而无声。脾湿动而为痰，而成嗽，皆积于脾也。盖因伤于肺气，动于脾湿，咳而为嗽也
。若脾无留湿，虽伤肺气而不为痰也。然寒、暑、燥、湿、风、火皆令人咳。唯湿痰，饮食
入胃留之而不行，上入于肺，则为咳嗽也。假令湿在心经，谓之热痰；湿在肝经，谓之风痰
；湿在肺经，谓之气痰；湿在肾经，谓之寒痰。
《三因》论 咳者，卫气之失；嗽者，营血之失。外伤六气，随风、寒、暑、湿
、燥、火感
其部位，而察其元以表之。内伤七情，皆聚于胃而关于肺，多痰嗽也。卫气之失，则多痰逆
；营气之失，则多痰嗽也。
张论 以贫富言之。贫者，谓之咳嗽，外感之由也。《内经》曰∶秋伤乎湿，冬
必咳嗽是也
。又曰∶岁火太过，肺金受病，民病咳嗽是也。富贵者，谓之涎嗽，多饮食浓味，热痰所成
也。
李论 皆脾弱受病，肺金受邪，饮食不化精微，留积而成痰，肺气不利，而痰冲
清道而成咳。
刘论 皆脾湿入于肺而成痰，伤风而成咳。
痰嗽潮热四证 有痰嗽者，潮热大体虽同，动作有异。或因虚中寒冷，则先痰嗽
，嗽久而不已，血形如线，随痰而出，恶寒发热，右寸浮而数；外证，日轻夜重，面白痰清
。
因忧愁大怒，则吐血而后痰嗽，少寒多热，左寸沉小而数；外证，心下噎塞，情思不乐
，饮食不下。
或蛊注相传，死魂相逐，则先呕血，不知来处，微有痰嗽，渐成寒热，两手脉弦细而数
，外证，饮食不为肌肤，颊红变动不常，身体酸痛倦，及嗽损咽痛多痰，或喘或泻则死。
先因伤湿、伤寒解利不尽，虽病退人起，饮食减少，不生肌肉，身倦无力，劳力则热，
身体酸痛，状如劳伏，但不吐血，不发潮热，经二三年医无验。此是余毒伏在经络，其脉弦
也，再发则愈。
《三因》论状 伤风咳者，憎寒壮热，自汗恶风，口干烦躁。伤寒咳者，憎寒发
热，无汗恶
寒，不干烦躁。伤暑咳者，烦热引饮，口燥，或吐沫，声嘶咯血。伤湿咳者，骨节烦痛，四
肢重者，洒洒淅淅。喜伤心，咳而喉仲介介如肿状。甚则咽肿喉痹，自汗咽干，咯血。此劳
伤心，小肠受之，咳与气俱失。怒伤肝，咳而两胁下痛，不可转侧，则两 下满，左胁偏痛
引少腹。此怒伤肝，胆受之，咳呕胆汁。思伤脾，咳而右胁下痛，隐隐引肩背。甚则不可动
，腹胀心痛，不欲食。此饥饱之伤，胃受之，咳而呕，呕则长虫出，忧伤肺，咳而喘息有声
。甚则吐血，吐白沫涎，口燥声嘶。叫呼伤肺，大肠受之，咳而遗矢。恐伤肾，咳而腰背
相
引痛。甚则嗔，咳涎，寒热，引腰背，或喘满。房劳伤肾，膀胱受之，咳而遗溺。久咳不已
，三焦受之，咳而腹满不饮食。
咳、嗽、喘、逆气、短气分别不同。
咳者，无痰有声，喉中如痒，习习如梗，甚则续续不止，连连不已，冲膈击胸。外有心
咳、一切血证、肺咳上逆。
嗽者，有痰。外有劳瘵喘促嗽血、肺痿、肺痈。
喘者，促促而气急，喝喝而息数，张口抬肩，摇身攘肚。外有香港脚。
逆气者，但香港脚上而奔急。外有肺中风、肺中暑、肺热、肺寒、肺水、肺痹、肝热胆寒
、心热肠痹、痰水。
短气者，呼吸难，数则不能相续，似喘而不摇肩，似呻吟而无痛。外有脾中风、脾中寒
、肺热、肾虚、历节风、忧气、胸痞、痰饮。
【治】 咳嗽谓无痰而有声。《素问》云∶咳乃皮毛先受邪气以从其合，其寒饮
食入胃，从脾脉上至肺，肺寒则内外合邪，因有咳证。
肺咳，麻黄汤；大肠遗矢，赤石脂禹余粮汤、桃仁汤。
脾咳，升麻汤；胃吐虫出，乌梅汤。
心咳，桂枝汤；小肠气失，芍药甘草汤。
肝咳，小柴胡汤；胆呕苦汁，黄芩半夏汤。
肾虚，麻黄细辛附子汤；膀胱遗溺，茯苓甘草汤。
久咳不已，三焦受之。其状，咳，腹满不欲饮食。此皆聚于胃，关于肺，令人多涕唾而
面浮肿气逆也。异功白术散。
逆，逆谓气上逆肺，壅而不下。上气逆者，皂荚丸；火逆上气，麦门冬汤；上气脉浮者
，麻黄浓补汤；上气脉沉者，泽漆汤。泽漆（五）、桑白皮（六）、射干（泔浸）、黄芩、白术、
茯苓（四）、竹茹，治气上逆，为热所作。
治法 无痰而有声者，以辛润其肺，青皮以散三焦之气壅。有痰而嗽者，治痰为
先，下气为上。痰而能食者，下之。不能食者，浓朴汤治之。痰而热者，柴胡汤加石膏主之
；痰而寒者，小青龙加桃仁主之。
张之治痰 以通圣散加半夏。暑嗽以白虎、凉膈；火嗽以黄连解毒；湿嗽以五苓
、白术；燥嗽以木香葶苈散；寒嗽以宁神宁肺散，为上也。更分以吐、汗、下为佳。
方 南星、半夏、枳壳、陈皮。风痰脉弦，加通圣；热痰脉滑，小柴胡，洪加青黛、连
；气痰脉涩，加青、陈皮；湿痰脉缓，加术、防己；寒痰脉沉，加桂、杏、小青龙；发热加
芩、桔；痞加枳实，重加茯苓；气上逆加葶苈；气促加参、桔；浮肿加郁李仁、杏仁、泽泻
、茯苓；上热喘涌，加寒水石、石膏；大便秘加大黄；能食加大承气；不能食加朴。
利膈丸 治胸中不利，痰嗽喘促。
木香 槟榔（一钱半） 枳实（炒，一两） 朴（三两） 大黄（酒制，一两） 人参 当归（
各三钱）
紫苏饮子 治脾肺受寒，痰涎嗽。
紫苏子 桑白皮 青皮 陈皮 杏仁 麻黄 炙甘草 五味子 半夏 人参。
千缗汤 治痰妙。
半夏（一两，生） 大皂角（半两，去皮子） 雄黄加之（大治痰）
上同入绢袋中，水三升，姜八片，煎至半，以手操洗之，取清汁服。
大热大饮凝于胸中而成湿，故痰作矣。宜吐之。
二陈汤加麻黄杏仁汤 治风寒。行痰开腠理。本方加麻黄、杏仁、桔梗。
降火导痰汤 治火。
黄芩 黄连 栝蒌 海石
劳嗽丹 四物 竹沥 姜汁
敛肺丹 治肺胀及火郁。
诃子 杏仁 青黛 栝蒌 半夏 香附
积痰方 南星 半夏 青黛 栝蒌 石碱
如肝痛，疏肝气，加青皮；上半日咳，多属胃火，加贝母、石膏；下半日嗽，多属阴虚
，加知母、柏、川芎、归；虚甚好色者，加参、膏、青陈皮、姜。
酒病嗽 白矾（一两，另研） 杏仁（一升）
上水一升，煎干，摊新瓦上，露一宿，砂锅内炒干。每夜饭后，细嚼杏仁十五个。
劫嗽方 五味（半两） 甘草（二钱） 五倍子风化硝（各一钱）
为末，干噙化。
鹅管法 治风入肺管。
南星 雄黄 款冬花 鹅石
上为末，入艾中，放姜片上，置舌上灸，吸烟入喉，以多为妙。
痰方 若或痰白作泡，当于肺中泻水。
滑石 川贝母 半夏 风化硝 白芥子 陈皮 茯苓 皂角（风加） 苍术（湿加） 栝蒌
（润加） 枳实（结加） 青黛 黄芩（热加）
青礞石丸 化痰。
麝香丸 治痰。
劳嗽方 四君子 百合 款冬花 细辛 肉桂 五味子 阿胶 半夏 天门冬
杏子 白芍 甘草
煎食。
《三因》论 因怒而伤者，甘草；忧而伤者，枳壳；喜而伤者，五味；悲而伤者
，人参。
【脉象】
脉象从鱼际处溢出，伴有气逆喘息。脉象弦主咳嗽。咳嗽且脉浮的，四十日可愈；咳嗽且脉弦的，观察患者体质强健者，采用涌吐法即可痊愈；咳嗽且脉虚的，必然感到头目昏眩；咳嗽且脉沉的，不可使用发汗法。气喘咳嗽、气机上逆，脉数且有发热，不能平卧的，预后不良（死证）；气机上逆，面部浮肿，呼吸时耸肩（肩息），脉象浮大的，预后不良（死证）；久咳数年，脉象弱的能生，脉象实大的预后不良（死证）；气机上逆，喘息声音高低不平，脉象滑利，手足温热的能生，脉象涩滞，四肢寒冷的预后不良（死证）；咳嗽，形体脱失消瘦且发热，脉象小坚急的预后不良（死证）；肌肉消瘦，下部肌肉萎缩，发热不退的预后不良（死证）；咳嗽脉象沉紧的预后不良（死证），脉象浮直的生，脉象浮软的能生，脉象小沉伏的预后不良（死证）；咳嗽伴呕吐，腹部胀满且腹泻，脉象弦急欲绝的预后不良（死证）；咳嗽身体瘦弱，脉象形大坚硬的预后不良（死证）。突然剧烈咳嗽，脉象散的预后不良（死证）。
脉浮主风邪，脉紧主寒邪，脉数主热邪，脉细主湿邪，这些是由外邪搏击所致；脉浮紧主虚寒，脉沉数主实热，脉弦涩主血少，脉洪滑主多痰，这些是由内气郁结所致。
风寒致病主要影响肺脏，因为肺主皮毛而统摄体表。风寒侵袭肌表，腠理闭塞不通，风寒内郁于肺，导致肺的清肃之气不利而生痰引发咳嗽。另外，寒冷饮食进入胃中，通过脾脉上行至肺，使肺受寒，肺寒则内外邪气相合，因而引起咳嗽。火邪引起的咳嗽，病因是火盛生痰，灼伤肺金，于是形成郁遏胀满。严重时出现干咳无痰，或唾出血痰。因劳损导致的咳嗽，多因房事过度导致肾虚，肾为肝之子，子病及母（肾水亏虚不能滋养肝木，进而影响全身气血），导致气血俱虚，阴虚则生内火，耗败肺金，津液和气血都化为痰饮。痰饮阻碍清气的升降，阻滞气机运行，从而形成各种咳嗽证候。
论述将咳逆痰嗽分为两类：咳，指没有痰但有声音。这是肺气受伤而不清肃，气机上逆，都与肺有关。嗽，指有痰但没有声音。这是脾湿动而生痰，从而形成嗽，都与脾积有关。大概是因为肺气受伤，脾湿发动，咳而转为嗽。如果脾中没有留湿，即使伤了肺气也不会生痰。然而，寒、暑、燥、湿、风、火六淫皆令人咳嗽。唯有湿痰，饮食入胃后停留不行，上泛于肺，则成为咳嗽。假如湿邪在心经，称为热痰；湿邪在肝经，称为风痰；湿邪在肺经，称为气痰；湿邪在肾经，称为寒痰。
《三因方》论述：咳，是卫气失调；嗽，是营血失调。外伤六气（风、寒、暑、湿、燥、火），根据感邪的部位不同，察其本源以辨别表里。内伤七情（喜、怒、忧、思、悲、恐、惊），皆聚于胃而关乎肺，多表现为痰嗽。卫气失调，则多痰气上逆；营气失调，则多痰嗽。
张景岳论述：从贫富角度区分。贫者，称为咳嗽，多由外感引起。《内经》说：“秋伤于湿，冬必咳嗽”，就是这个道理。又说：“岁火太过，肺金受病，民病咳嗽”，也是这个意思。富贵者，称为涎嗽，多因饮食肥甘厚味，形成热痰所致。
李东垣论述：都是脾弱受病，肺金受邪，饮食不能化生精微，停留积聚而成痰，肺气不利，痰冲犯清道而成咳。
痰嗽潮热四证辨析：有痰嗽的人，潮热大体相似，但动作表现各异。
或因虚中寒冷，先出现痰嗽，咳嗽久而不愈，血丝如线，随痰而出，恶寒发热，右寸脉浮而数；外在症状表现为白天轻晚上重，面色白，痰清稀。
因忧愁大怒，先吐血而后痰嗽，怕冷多发热，左寸脉沉小而数；外在症状表现为心下噎塞，心情不乐，饮食不下。
或因蛊注相传，死魂相逐（指寄生虫病或精神因素导致的类似症状），先呕血，不知来源，轻微痰嗽，逐渐形成寒热往来，两手脉弦细而数；外在症状表现为饮食不能转化为肌肤营养，脸颊红赤变动无常，身体酸痛疲倦，以及咳嗽损伤咽喉疼痛多痰，或喘或泻则预后不良（死证）。
先前因伤湿、伤寒解表不尽，虽然病退人起，饮食减少，不生肌肉，身体疲倦无力，劳累则发热，身体酸痛，状似劳倦潜伏，但不吐血，不发潮热，经过两三年医治无效。这是余毒伏在经络，脉象弦，再发作则会痊愈（此处原文逻辑可能有误，通常伏邪复发加重，但依原文翻译）。
《三因方》论述症状：伤风咳嗽，憎寒壮热，自汗恶风，口干烦躁。伤寒咳嗽，憎寒发热，无汗恶寒，不干躁。伤暑咳嗽，烦热引饮，口燥，或吐沫，声嘶咯血。伤湿咳嗽，骨节烦痛，四肢沉重，洒淅恶寒。喜伤心，咳嗽而喉中介介如肿状。甚则咽肿喉痹，自汗咽干，咯血。此为劳伤心，小肠受之，咳与气俱失。怒伤肝，咳嗽而两胁下痛，不可转侧，则两胁下满，左胁偏痛引少腹。此为怒伤肝，胆受之，咳呕胆汁。思伤脾，咳嗽而右胁下痛，隐隐引肩背。甚则不可动，腹胀心痛，不欲食。此为饥饱之伤，胃受之，咳嗽而呕，呕则长虫出。忧伤肺，咳嗽而喘息有声。甚则吐血，吐白沫涎，口燥声嘶。叫呼伤肺，大肠受之，咳嗽而遗矢（大便失禁）。恐伤肾，咳嗽而腰背相引痛。甚则嗔（愤怒/惊恐），咳涎，寒热，引腰背，或喘满。房劳伤肾，膀胱受之，咳嗽而遗溺。久咳不已，三焦受之，咳嗽而腹满不饮食。
咳、嗽、喘、逆气、短气分别不同。
咳，无痰有声，喉中如痒，习习如梗，甚则续续不止，连连不已，冲膈击胸。外在兼有心咳、一切血证、肺咳上逆。
嗽，有痰。外在兼有劳瘵喘促嗽血、肺痿、肺痈。
喘，促促而气急，喝喝而息数，张口抬肩，摇身攘肚。外在兼有香港脚（脚气病）。
逆气，但香港脚上而奔急。外在兼有肺中风、肺中暑、肺热、肺寒、肺水、肺痹、肝热胆寒、心热肠痹、痰水。
短气，呼吸难，数则不能相续，似喘而不摇肩，似呻吟而无痛。外在兼有脾中风、脾中寒、肺热、肾虚、历节风、忧气、胸痞、痰饮。
【治疗】
咳嗽指无痰而有声。《素问》说：咳乃皮毛先受邪气以从其合，其寒饮食入胃，从脾脉上至肺，肺寒则内外合邪，因有咳证。
肺咳，用麻黄汤；大肠遗矢（大便失禁），用赤石脂禹余粮汤、桃仁汤。
脾咳，用升麻汤；胃吐虫出，用乌梅汤。
心咳，用桂枝汤；小肠气失（气机失调），用芍药甘草汤。
肝咳，用小柴胡汤；胆呕苦汁，用黄芩半夏汤。
肾虚，用麻黄细辛附子汤；膀胱遗溺（小便失禁），用茯苓甘草汤。
久咳不已，三焦受之。其状，咳，腹满不欲饮食。此皆聚于胃，关于肺，令人多涕唾而面浮肿气逆也。用异功白术散。
逆，逆谓气上逆肺，壅而不下。上气逆者，用皂荚丸；火逆上气，用麦门冬汤；上气脉浮者，用麻黄浓补汤；上气脉沉者，用泽漆汤。泽漆（五钱）、桑白皮（六钱）、射干（泔浸洗）、黄芩、白术、茯苓（四钱）、竹茹，治气上逆，为热所作。
治法：无痰而有声者，以辛润其肺，青皮以散三焦之气壅。有痰而嗽者，治痰为先，下气为上。痰而能食者，下之。不能食者，用浓朴汤治之。痰而热者，用柴胡汤加石膏主之；痰而寒者，用小青龙加桃仁主之。
张景岳治痰：用通圣散加半夏。暑嗽用白虎汤、凉膈散；火嗽用黄连解毒汤；湿嗽用五苓散、白术散；燥嗽用木香葶苈散；寒嗽用宁神宁肺散，为上策。更分以吐、汗、下法为佳。
方剂：南星、半夏、枳壳、陈皮。风痰脉弦，加通圣散；热痰脉滑，用小柴胡汤，洪大加青黛、连翘；气痰脉涩，加青皮、陈皮；湿痰脉缓，加白术、防己；寒痰脉沉，加桂枝、杏仁、小青龙汤；发热加黄芩、桔梗；痞满加枳实，重者加茯苓；气上逆加葶苈子；气促加人参、桔梗；浮肿加郁李仁、杏仁、泽泻、茯苓；上热喘涌，加寒水石、石膏；大便秘加大黄；能食加大承气汤；不能食加厚朴。
利膈丸：治胸中不利，痰嗽喘促。
木香 槟榔（一钱半） 枳实（炒，一两） 厚朴（三两） 大黄（酒制，一两） 人参 当归（各三钱）
紫苏饮子：治脾肺受寒，痰涎嗽。
紫苏子 桑白皮 青皮 陈皮 杏仁 麻黄 炙甘草 五味子 半夏 人参。
千缗汤：治痰妙方。
半夏（一两，生用） 大皂角（半两，去皮子） 雄黄加之（大治痰）
以上同入绢袋中，水三升，姜八片，煎至半量，用手搓洗药袋，取清汁服用。
二陈汤加麻黄杏仁汤：治风寒。行痰开腠理。本方加麻黄、杏仁、桔梗。
如肝痛，疏肝气，加青皮；上半日咳，多属胃火，加贝母、石膏；下半日嗽，多属阴虚，加知母、柏子仁、川芎、当归；虚甚好色者，加人参、膏滋、青皮陈皮、生姜。
酒病嗽：白矾（一两，另研） 杏仁（一升）
以上用水一升，煎干，摊新瓦上，露一宿，砂锅内炒干。每夜饭后，细嚼杏仁十五个。
劫嗽方：五味子（半两） 甘草（二钱） 五倍子风化硝（各一钱）
为末，干噙化。
鹅管法：治风入肺管。
南星 雄黄 款冬花 鹅管石
以上为末，入艾中，放姜片上，置舌上灸，吸烟入喉，以多为妙。
痰方：若或痰白作泡，当于肺中泻水。
滑石 川贝母 半夏 风化硝 白芥子 陈皮 茯苓 皂角（风加） 苍术（湿加） 栝蒌（润加） 枳实（结加） 青黛 黄芩（热加）
青礞石丸：化痰。
麝香丸：治痰。
[Pulse]
The pulse emerges from the Yuji point (LU10), accompanied by rebellious Qi and panting. A wiry pulse indicates cough. If the cough is accompanied by a floating pulse, it will resolve in forty days; if the cough is accompanied by a wiry pulse, observe if the patient is strong; if so, vomiting therapy can cure it; if the cough is accompanied by a deficient pulse, the patient must suffer from dizziness and vertigo; if the cough is accompanied by a deep pulse, sweating therapy is contraindicated. Panting, coughing, and rebellious Qi with a rapid pulse and fever, inability to lie down, indicate a fatal prognosis; rebellious Qi with facial edema, shoulder breathing (shrugging shoulders to breathe), and a large floating pulse indicate a fatal prognosis; chronic cough for years with a weak pulse indicates survival, while a full and large pulse indicates a fatal prognosis; rebellious Qi with panting of varying pitch, a slippery pulse, and warm hands and feet indicate survival, while a choppy pulse and cold limbs indicate a fatal prognosis; cough with emaciation and fever, and a small, firm, and urgent pulse indicates a fatal prognosis; muscle wasting with lower body atrophy and persistent fever indicate a fatal prognosis; cough with a deep and tight pulse indicates a fatal prognosis, while a straight floating pulse or a soft floating pulse indicates survival, and a small, deep, and hidden pulse indicates a fatal prognosis; cough with vomiting, abdominal distension, and diarrhea, and a wiry and urgent pulse nearing extinction indicates a fatal prognosis; cough with emaciation and a large, firm pulse shape indicates a fatal prognosis. Sudden severe cough with a scattered pulse indicates a fatal prognosis.
A floating pulse indicates Wind, a tight pulse indicates Cold, a rapid pulse indicates Heat, and a fine pulse indicates Dampness; these arise from the struggle with external pathogens. A floating and tight pulse indicates deficiency Cold, a deep and rapid pulse indicates excess Heat, a wiry and choppy pulse indicates Blood deficiency, and a surging and slippery pulse indicates excessive Phlegm; these arise from internal Qi stagnation.
[Etiology and Symptoms]
Etiologies include Wind, Cold, Fire (accompanied by abdominal fullness), Fatigue, and Phlegm.
Wind-Cold diseases primarily affect the Lung, as the Lung governs the skin and hair and controls the exterior. When injured, the interstices do not open, allowing Wind-Cold to stagnate internally in the Lung, impairing its clear descending function and generating Phlegm and cough. Additionally, cold food entering the stomach travels up via the Spleen channel to the Lung, causing Lung Cold. Lung Cold leads to the combination of internal and external pathogens, resulting in cough. Cough due to Fire arises from excessive Fire generating Phlegm and scorching Lung Metal, leading to stagnation and fullness. In severe cases, dry cough without Phlegm or spitting of bloody Phlegm occurs. Cough due to Fatigue often results from sexual excess causing Kidney deficiency. As the Son (Water) drains the Mother (Metal/Wood relationship context implies mutual depletion), both Qi and Blood become deficient. Yin deficiency generates internal Fire, consuming Lung Metal, causing fluids and Qi/Blood to transform into Phlegm. Phlegm obstructs the ascending and descending of Clear Qi, stagnating Qi movement, thus forming various cough syndromes.
Discussion on dividing Rebellious Qi Cough and Phlegm Cough into two categories: Cough refers to sound without Phlegm. This is due to Lung Qi injury and lack of clarity, with Qi rebelling upward, involving the Lung. Saliva/Cough (Sou) refers to Phlegm without sound. This is due to Spleen Dampness moving to generate Phlegm, accumulating in the Spleen. Generally, Lung Qi injury combined with Spleen Dampness movement leads to cough turning into Sou. If the Spleen has no retained Dampness, even with Lung Qi injury, Phlegm will not form. However, Cold, Summer-Heat, Dryness, Dampness, Wind, and Fire all cause cough. Only Wet Phlegm, where food stays in the stomach without moving and rises to the Lung, causes cough. If Dampness is in the Heart channel, it is called Hot Phlegm; in the Liver channel, Wind Phlegm; in the Lung channel, Qi Phlegm; in the Kidney channel, Cold Phlegm.
*San Yin Fang* Discussion: Cough is a loss of Wei Qi; Sou is a loss of Ying Blood. External injury by Six Qi (Wind, Cold, Summer-Heat, Dampness, Dryness, Fire) depends on the site of infection to determine the root and manifest externally. Internal injury by Seven Emotions gathers in the Stomach and relates to the Lung, mostly causing Phlegm Sou. Loss of Wei Qi leads to much Phlegm and rebellion; loss of Ying Qi leads to much Phlegm Sou.
Zhang’s Discussion: From the perspective of wealth and poverty. The poor have "Cough," caused by external contraction. *Nei Jing* states: "Injury by Dampness in Autumn leads to Cough in Winter." It also states: "Excessive Fire year, Lung Metal is diseased, people suffer Cough." The wealthy have "Saliva Sou," caused by rich and greasy diet forming Hot Phlegm.
Li’s Discussion: All are due to weak Spleen disease and Lung Metal pathogen invasion. Food fails to transform into essence, accumulates as Phlegm, Lung Qi becomes unfavorable, and Phlegm rushes through the clear passages causing cough.
Liu’s Discussion: All are due to Spleen Dampness entering the Lung to form Phlegm, and Wind injury causing cough.
Four Syndromes of Phlegm Cough and Tidal Fever: Patients with Phlegm Cough have similar tidal fevers but different movements.
If due to Cold within Deficiency, Phlegm Cough appears first. Chronic cough that does not heal produces blood threads like lines coming out with Phlegm, aversion to cold and fever, right Cun pulse floating and rapid; external signs include lighter symptoms by day and heavier by night, white face, and clear Phlegm.
Due to sorrow and great anger, hemoptysis occurs followed by Phlegm Cough, more aversion to cold than fever, left Cun pulse deep, small, and rapid; external signs include epigastric blockage, unhappiness, and inability to eat.
Due to Gu Zhong transmission or chasing dead souls (parasitic/spiritual issues), hematemesis occurs first with unknown origin, slight Phlegm Cough, gradually forming alternating chills and fever, bilateral pulses wiry, small, and rapid; external signs include food failing to nourish flesh, red cheeks changing frequently, body soreness and fatigue, cough damaging throat with pain and much Phlegm, or panting/diarrhea indicating death.
Initially injured by Dampness or Cold, incomplete resolution allows recovery but with reduced appetite, failure to gain muscle, body fatigue, exertion-induced fever, body soreness, resembling latent fatigue, but no hemoptysis or tidal fever. Medical treatment for 2-3 years is ineffective. This is residual toxin lying in collaterals, pulse is wiry; recurrence leads to healing (Note: Text logic may imply worsening, but translated literally).
*San Yin Fang* Symptom Description: Wind-injury Cough involves aversion to cold with high fever, spontaneous sweating, aversion to wind, dry mouth, and irritability. Cold-injury Cough involves aversion to cold with fever, no sweating, aversion to cold, no dryness/irritability. Summer-Heat-injury Cough involves烦热 (restless heat) with desire to drink, dry mouth, possibly spitting foam, hoarseness, and hemoptysis. Dampness-injury Cough involves painful joints, heavy limbs, and shivering. Joy injures the Heart, causing cough with throat feeling swollen. Severe cases involve swollen throat and bi-syndrome, spontaneous sweating, dry throat, hemoptysis. This is Labor injuring the Heart, Small Intestine affected, cough with Qi loss. Anger injures the Liver, causing cough with pain in both hypochondria, inability to turn, fullness in both flanks, left flank pain radiating to lower abdomen. This is Anger injuring the Liver, Gallbladder affected, cough with bitter bile vomiting. Thought injures the Spleen, causing cough with pain in right hypochondrium radiating to shoulder/back. Severe cases involve immobility, abdominal distension, heart pain, anorexia. This is Hunger/Fatigue injuring the Stomach, cough with vomiting, expelling roundworms. Sorrow injures the Lung, causing cough with wheezing sounds. Severe cases involve hemoptysis, spitting white foam/saliva, dry mouth, hoarseness. Shouting injures the Lung, Large Intestine affected, cough with fecal incontinence. Fear injures the Kidney, causing cough with pulling pain in waist/back. Severe cases involve anger/fear, coughing saliva, chills/fever, pulling pain in waist/back, or panting/fullness. Sexual fatigue injures the Kidney, Bladder affected, cough with urinary incontinence. Long-term cough affects the Triple Burner, causing cough with abdominal fullness and anorexia.
Distinction between Cough, Sou, Panting, Rebellious Qi, and Shortness of Breath.
Cough: No Phlegm, with sound, throat itching, sensation of obstruction, continuous and unceasing, striking diaphragm and chest. Externally associated with Heart Cough, all blood syndromes, Lung Cough with rebellion.
Sou: With Phlegm. Externally associated with Consumption with panting/hemoptysis, Lung萎 (Atrophy), Lung Abscess.
Panting: Rapid and urgent breathing, noisy respiration, opening mouth and raising shoulders, shaking body and belly. Externally associated with Hong Kong Foot (Gouty Arthritis/Edema).
Rebellious Qi: Hong Kong Foot rising urgently. Externally associated with Lung Wind, Lung Summer-Heat, Lung Heat, Lung Cold, Lung Water, Lung Bi, Liver Heat/Gallbladder Cold, Heart Heat/Intestine Bi, Phlegm-Water.
Shortness of Breath: Difficult breathing, frequent but unable to continue, resembles panting but without shoulder shaking, resembles groaning but without pain. Externally associated with Spleen Wind, Spleen Cold, Lung Heat, Kidney Deficiency, Li Jie Feng (Rheumatism), Worry Qi, Chest Fullness, Phlegm-Fluid.
[Treatment]
Cough refers to sound without Phlegm. *Su Wen* states: Cough begins with pathogen invading skin/hair following the interior connection. Cold drinks enter the stomach, travel up via Spleen channel to Lung, Lung Cold combines internal/external pathogens, causing Cough.
Lung Cough: Ma Huang Tang (Ephedra Decoction); Large Intestine fecal incontinence: Chi Shi Zhi Yu Liang Tang (Red Halloysite and Yuzhuang Decoction), Tao Ren Tang (Apricot Kernel Decoction).
Spleen Cough: Sheng Ma Tang (Cimicifuga Decoction); Stomach vomiting worms: Wu Mei Tang (Mume Decoction).
Heart Cough: Gui Zhi Tang (Cinnamon Twig Decoction); Small Intestine Qi loss: Shao Yao Gan Cao Tang (Peony and Licorice Decoction).
Liver Cough: Xiao Chai Hu Tang (Minor Bupleurum Decoction); Gallbladder vomiting bitter juice: Huang Qin Ban Xia Tang (Scutellaria and Pinellia Decoction).
Kidney Deficiency: Ma Huang Xi Xin Fu Zi Tang (Ephedra, Asarum, and Aconite Decoction); Bladder urinary incontinence: Fu Ling Gan Cao Tang (Poria and Licorice Decoction).
Long-term cough affecting Triple Burner: Symptoms include cough, abdominal fullness, anorexia. These gather in Stomach, relate to Lung, causing much sputum, facial edema, and Qi rebellion. Yi Gong Bai Zhu San (Yi Gong Atractylodes Powder).
Rebellion: Qi rebelling in Lung, obstructed and not descending. Rebellious Qi: Zao Jiao Wan (Gleditsia Pill). Fire-rebellious Qi: Mai Men Dong Tang (Ophiopogon Decoction). Rebellious Qi with floating pulse: Ma Huang Nong Bu Tang (Ephedra Strong Tonifying Decoction). Rebellious Qi with deep pulse: Ze Qi Tang (Phytolacca Decoction). Ze Qi (5 qian), Sang Bai Pi (6 qian), She Ye (soaked in rice water), Huang Qin, Bai Zhu, Fu Ling (4 qian), Zhu Ru. Treats Qi rebellion caused by Heat.
Treatment Methods: Sound without Phlegm: Use acrid to moisten Lung, Qing Pi to dissipate Triple Burner Qi stagnation. Phlegm with Sou: Treat Phlegm first, descend Qi. Phlegm with ability to eat: Purge. Unable to eat: Hou Po Tang (Magnolia Bark Decoction). Phlegm with Heat: Chai Hu Tang plus Shi Gao (Gypsum). Phlegm with Cold: Xiao Qing Long Tang plus Tao Ren (Apricot Kernel).
Zhang’s Treatment of Phlegm: Tong Sheng San plus Ban Xia. Summer-Heat Sou: Bai Hu Tang (White Tiger Decoction), Liang Ge San (Cool Diaphragm Powder). Fire Sou: Huang Lian Jie Du Tang (Coptis Detoxification Decoction). Damp Sou: Wu Ling San (Five Poria Powder), Bai Zhu San (Atractylodes Powder). Dry Sou: Mu Xiang Ting Li San (Costus and Lepidium Powder). Cold Sou: Ning Shen Ning Fei San (Calming Spirit and Lung Powder), superior method. Further divide by Vomiting, Sweating, Purging.
Formulas: Nan Xing (Arisaema), Ban Xia (Pinellia), Zhi Ke (Bitter Orange), Chen Pi (Tangerine Peel). Wind Phlegm wiry pulse: Add Tong Sheng San. Hot Phlegm slippery pulse: Xiao Chai Hu Tang, add Qing Dai (Indigo) and Lian Qiao (Forsythia) if surging. Qi Phlegm choppy pulse: Add Qing Pi, Chen Pi. Damp Phlegm slow pulse: Add Bai Zhu, Fang Ji. Cold Phlegm deep pulse: Add Gui Zhi, Xing Ren, Xiao Qing Long Tang. Fever: Add Huang Qin, Jie Geng. Fullness: Add Zhi Shi, heavy case add Fu Ling. Qi rebellion: Add Ting Li Zi. Shortness of breath: Add Ren Shen, Jie Geng. Edema: Add Yu Li Ren, Xing Ren, Ze Xie, Fu Ling. Upper Heat panting: Add Han Shui Shi, Shi Gao. Constipation: Add Da Huang. Ability to eat: Add Da Cheng Qi Tang. Unable to eat: Add Hou Po.
Li Ge Wan: Treats chest discomfort, Phlegm Sou, panting.
Mu Xiang, Bing Lang (1.5 qian), Zhi Shi (fried, 1 liang), Hou Po (3 liang), Da Huang (wine-processed, 1 liang), Ren Shen, Dang Gui (each 3 qian).
Zi Su Yin Zi: Treats Spleen/Lung Cold injury, Phlegm-saliva Sou.
Zi Su Zi, Sang Bai Pi, Qing Pi, Chen Pi, Xing Ren, Ma Huang, Zhi Gan Cao, Wu Wei Zi, Ban Xia, Ren Shen.
Qian Min Tang: Excellent for Phlegm.
Ban Xia (1 liang, raw), Da Zao Jiao (0.5 liang, peeled/seeded), Xiong Huang added (excellent for Phlegm).
Put all in silk bag, boil in 3 sheng water with 8 ginger slices until half volume, wash bag by hand, take clear juice.
Great Heat and Great Drink condense in chest forming Dampness, thus Phlegm forms. Induce vomiting.
Er Chen Tang plus Ma Huang Xing Ren Tang: Treats Wind-Cold. Moves Phlegm, opens interstices. Base formula plus Ma Huang, Xing Ren, Jie Geng.
Jiang Huo Dao Tan Tang: Treats Fire.
Huang Qin, Huang Lian, Gua Lou, Hai Shi (Sea Stone).
Lao Sou Dan: Si Wu Tang, Zhu Li (Bamboo Juice), Jiang Zhi (Ginger Juice).
Lian Fei Dan: Treats Lung distension and Fire stagnation.
He Zi, Xing Ren, Qing Dai, Gua Lou, Ban Xia, Xiang Fu.
Ji Tan Fang: Nan Xing, Ban Xia, Qing Dai, Gua Lou, Shi Jian (Alkali).
If Liver pain, soothe Liver Qi, add Qing Pi. Cough in first half of day: mostly Stomach Fire, add Bei Mu, Shi Gao. Cough in second half of day: mostly Yin Deficiency, add Zhi Mu, Bai Zi, Chuan Xiong, Dang Gui. Severe deficiency with lust: add Ren Shen, Gao (Paste), Qing Pi, Chen Pi, Sheng Jiang.
Wine Disease Sou: Bai Fan (1 liang, separately ground), Xing Ren (1 sheng).
Boil in 1 sheng water until dry, spread on new tile, expose overnight, stir-fry dry in clay pot. Chew 15 Xing Ren finely after dinner nightly.
Jie Sou Fang: Wu Wei Zi (0.5 liang), Gan Cao (2 qian), Wu Bei Zi, Feng Hua Xiao (each 1 qian).
Grind to powder, hold in mouth to dissolve.
E Guan Fa: Treats Wind entering Lung tube.
Nan Xing, Xiong Huang, Kuan Dong Hua, E Shi (Goose Tube Stone).
Grind to powder, mix with Mugwort, place on Ginger slice, moxibustion on tongue, smoke inhales into throat, more is better.
Tan Fang: If Phlegm is white and foamy, drain Water from Lung.
Hua Shi, Chuan Bei Mu, Ban Xia, Feng Hua Xiao, Bai Jie Zi, Chen Pi, Fu Ling, Zao Jiao (add for Wind), Cang Zhu (add for Dampness), Gua Lou (add for Dryness), Zhi Shi (add for Knotting), Qing Dai, Huang Qin (add for Heat).
Qing Meng Shi Wan: Resolves Phlegm.
She Xiang Wan: Treats Phlegm.
Lao Sou Fang: Si Jun Zi Tang, Bai He, Kuan Dong Hua, Xi Xin, Rou Gui, Wu Wei Zi, E Jiao, Ban Xia, Tian Men Dong, Xing Zi, Bai Shao, Gan Cao.
Decoct and eat.
*San Yin Fang* Discussion: Injury by Anger: Gan Cao; Injury by Sorrow: Zhi Ke; Injury by Joy: Wu Wei Zi; Injury by Grief: Ren Shen.